Individual
DESIREE L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8727
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 779-8187
(270) 798-8224
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04614
TX
363AS0400X
Surgical Physician Assistant
PA04614
TX
Other
Enumeration date
04/22/2006
Last updated
01/22/2024
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